养心安神汤辅助治疗气阴两虚型慢性心力衰竭合并失眠74例临床观察

Clinical observation on 74 cases of chronic Heart failure complicated with Insomnia of deficiency of both Qi and Yin treated with Yangxin Anshen decoction

目的观察养心安神汤辅助治疗气阴两虚型慢性心力衰竭合并失眠患者的临床疗效。方法选取气阴两虚型慢性心力衰竭合并失眠患者74例,随机分为观察组和对照组,每组37例。对照组给予西医基础治疗,观察组在西医基础治疗的同时联合养心安神汤每次1袋,每日2次口服,疗程均为8周。对两组患者在治疗前后进行纽约心脏病协会(NYHA)心功能分级、中医症候积分、六分钟步行距离(6MWD)、匹兹堡睡眠质量指数(PSQI)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、明尼苏达州心功能不全生命质量量表(MLHFQ)评估,并测定N末端脑钠肽前体(NT-proBNP)水平、左室射血分数(LVEF)、每搏输出量(SV)、总睡眠时间(TST)、睡眠效率(SE)、快速动眼期(REM)水平。结果两组患者治疗后6MWD、LVEF、SV、TST、SE及REM均较治疗前高(P<0.01),中医症候积分、血清NT-proBNP水平、PSQI评分、HAMA评分及HAMD评分均较治疗前低(P<0.01),观察组治疗后MLHFQ评分较治疗前低(P<0.01),对照组治疗后MLHFQ评分改善不明显(P>0.05)。观察组患者心功能疗效、睡眠疗效的总有效率分别为94.29%、91.43%,对照组分别为77.78%、80.56%,观察组明显高于对照组(P<0.05)。观察组6MWD、MLHFQ、LVEF、SV、NT-proBNP、PSQI、HAMA、HAMD、TST、SE、REM、中医症候积分、心功能水平及睡眠疗效改善均较对照组明显(P<0.05或P<0.01)。结论养心安神汤联合西医基础治疗可有效改善气阴两虚型慢性心力衰竭合并失眠患者的心功能及睡眠状况,其作用机制可能与提高心肌收缩力、降低血清NT-proBNP水平及改善焦虑、抑郁情绪有关。

Objective To observe the clinical efficacy of Yangxin Anshen decoction in the treatment of chronic heart failure complicated with insomnia of deficiency of both Qi and Yin.Methods 74 patients with chronic heart failure complicated with insomnia with deficiency of both Qi and Yin were randomly divided into observation group(n=37)and control group(n=37).The control group was given basic treatment of western medicine,while the observation group was treated with Yangxin Anshen decoction 1 bag at a time,twice a day for 8 weeks.Before and after treatment,the patients in the two groups were evaluated by New York Heart Association(NYHA)cardiac function classification,TCM syndrome score,six-minute walking distance(6MWD),Pittsburgh Sleep quality Index(PSQI),Hamilton anxiety scale(HAMA),Hamilton Depression scale(HAMD),Minnesota Heart insufficiency quality of Life scale(MLHFQ).The levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),stroke volume(SV),total sleep time(TST),sleep efficiency(SE)and rapid eye movement(REM)were measured.Results After treatment,both groups of patients showed significant improvements in 6MWD,LVEF,SV,TST,SE,and REM compared to before treatment(P<0.01).The traditional Chinese medicine(TCM)syndrome score,serum NT-proBNP level,PSQI score,HAMA score,and HAMD score were all significantly lower than before treatment(P<0.01).The observation group showed a significant decrease in MLHFQ score after treatment compared to before treatment(P<0.01),while the control group showed no significant improvement in MLHFQ score(P>0.05).The total effective rate of cardiac function and sleep improvement in the observation group were 94.29%and 91.43%,respectively,while those in the control group were 77.78%and 80.56%,respectively,with the observation group being significantly higher than the control group(P<0.05).Furthermore,the observation group showed significant improvements in 6MWD,MLHFQ,LVEF,SV,NT-proBNP,PSQI,HAMA,HAMD,TST,SE,REM,TCM syndrome score,cardiac function level,and sleep efficacy compared to the control group(P<0.05 or P<0.01).Conclusion Yangxin Anshen decoction combined with western medicine can effectively improve the cardiac function and sleep status of patients with chronic heart failure complicated with insomnia of deficiency of both Qi and Yin,and its mechanism may be related to increasing myocardial contractility,reducing serum NT-proBNP level and improving anxiety and depression.